Thursday, August 25, 2011

Attention-Deficit/Hyperactivity Disorder (ADHD) (314.xx)

ADHD is characterized by a pattern of inattentive and/or hyperactive behavior that is more severe than what would normally be observed in a person of a similar developmental level.  Some of the symptoms have to be present before the age of 7.  Look for people who aren’t able to pay close attention to details; work may look messy and disorganized.  The person may jump from task to task without actually completing any.  They may seem like they are not paying attention in conversation & look like they aren’t listening.  You want to be certain, however, that the person is unable to complete tasks due to having difficulties with attention & not due to being oppositional.  Symptoms are more often observed in group settings than in individual settings, so even if a person doesn’t display any symptoms in your office, if you suspect ADHD, it may be worthwhile to observe in other settings. 

It is difficult to diagnose in children younger than age 4 – 5 & it would be exceedingly rare to be able to diagnose in a 2 or 3 year old, as it is normal for 2 – 3 year olds to flit from one thing to the next.  Generally, the symptoms become less noticeable as the person ages; adolescents might just look a little fidgety, or may just feel restless but be able to sit still.  Adults may look pretty normal, but may avoid desk jobs, or activities that require a lot of sitting still.  ADHD is more common in males than females.  Use caution in making an ADHD diagnosis, as it is easy to mistake the symptoms of something else for ADHD.  Some common misdiagnoses include mistaking a smart child who is bored in an under stimulating environment for being inattentive.  Oppositional behavior may look like ADHD at times.  Sometimes mood or anxiety disorders can cause children to have difficulty focusing or completing tasks.

On to the criteria!

  • Symptoms have to occur for more than six months, have to cause impairment & have to be inconsistent with what is considered normal for the stage of development.
  • Symptoms have to be present before the age of 7.
  • Impairment has to be observed in multiple settings (such as at home as well as at school).
Six or more of the following symptoms of inattention AND/OR
Six or more of the following symptoms of hyperactivity-impulsivity
-fails to give close attention or makes careless mistakes in work
-often has difficulty sustaining attention on play, work, or other activities
-seems not to listen, even when spoken to directly
-doesn’t follow through on instructions & doesn’t finish work (and is not due to being oppositional)
-has difficulty organizing tasks
-avoids/dislikes tasks that require sustained mental effort (like schoolwork or homework)
-loses things that are necessary to complete tasks or activities
-is easily distracted by extraneous stimuli (Hey, look, a chicken!)
-is forgetful
-often fidgets or squirms in seat
-leaves seat during class or elsewhere where remaining seated is expected
-runs around or climbs at inappropriate times (adolescents & adults may feel restless, and are less likely to be observed climbing on their desks during math class)
-has difficulty playing quietly
-is usually “on the go” or described as like the infamous Energizer bunny (Okay, so the DSM doesn’t use copyrighted terminology, but that’s what they mean.)
-talks too much
-blurts out answers before the question is finished being asked
-has difficulty waiting for his/her turn
-interrupts/intrudes on others, like interrupting conversations or games

  • ADHD combined type has 6 from both columns above
  • ADHD predominantly inattentive type has 6 from the 1st column & less than 6 from the 2nd
  • ADHD predominantly hyperactive-impulsive type has 6 from the 2nd column & less than 6 from the 1st
  • You can specify “In Partial Remission” for people, particularly adults & older adolescents, who no longer meet the full criteria.

No comments:

Post a Comment